COMPUTER-AIDED DIAGNOSIS IMPROVES CHARACTERIZATION OF BARRETT'S NEOPLASIA BY GENERAL ENDOSCOPISTS

Jelmer B Jukema; Carolus H J Kusters; Martijn R Jong; Kiki N Fockens; Tim Boers; Joost A van der Putten; Roos E Pouw; Lucas C Duits; BasL A M Weusten; Lorenza Alvarez Herrero; Martin H M G Houben; Wouter B Nagengast; Jessie Westerhof; Alaa Alkhalaf; Rosalie Mallant-Hent; Pieter Scholten; Krish Ragunath; Stefan Seewald; Peter Elbe; Francisco Baldaque Silva; Maximilien Barret; Jacobo Ortiz Fernández-Sordo; Guiomar Moral Villarejo; Oliver Pech; Torsten Beyna; Nahid S M Montazeri; Fons van der Sommen; Peter H de With; A Jeroen de Groof; Jacques J Bergman; BONS-AI consortium

doi:10.1016/j.gie.2024.04.013

COMPUTER-AIDED DIAGNOSIS IMPROVES CHARACTERIZATION OF BARRETT'S NEOPLASIA BY GENERAL ENDOSCOPISTS

Gastrointest Endosc. 2024 Apr 16:S0016-5107(24)00233-5. doi: 10.1016/j.gie.2024.04.013. Online ahead of print.

Authors

Jelmer B Jukema¹, Carolus H J Kusters², Martijn R Jong¹, Kiki N Fockens¹, Tim Boers², Joost A van der Putten², Roos E Pouw¹, Lucas C Duits¹, BasL A M Weusten³, Lorenza Alvarez Herrero⁴, Martin H M G Houben⁵, Wouter B Nagengast⁶, Jessie Westerhof⁶, Alaa Alkhalaf⁷, Rosalie Mallant-Hent⁸, Pieter Scholten⁹, Krish Ragunath¹⁰, Stefan Seewald¹¹, Peter Elbe¹², Francisco Baldaque Silva¹³, Maximilien Barret¹⁴, Jacobo Ortiz Fernández-Sordo¹⁵, Guiomar Moral Villarejo¹⁵, Oliver Pech¹⁶, Torsten Beyna¹⁷, Nahid S M Montazeri¹⁸, Fons van der Sommen², Peter H de With², A Jeroen de Groof¹, Jacques J Bergman¹⁹; BONS-AI consortium

Collaborators

BONS-AI consortium:
Alaa Alkhalaf²⁰, Lorenza Alvarez Herrero²¹, Francisco Baldaque-Silva²², Maximilien Barret²³, Jacques J Bergman²⁴, Torsten Beyna²⁵, Raf Bisschops²⁶, Tim G Boers²⁷, Wouter Curvers²⁸, Pierre H Deprez²⁹, Lucas C Duits²⁴, Peter Elbe³⁰, Jose Miguel Esteban³¹, Gary W Falk³², Kiki N Fockens²⁴, Gregory G Ginsberg³³, Albert J de Groof²⁴, Rehan Haidry³⁴, Martin H Houben³⁵, Anthony Infantolino³⁶, Prasad G Iyer³⁷, Martijn Jong²⁴, Pieter-Jan de Jonge³⁸, Jelmer B Jukema³⁹, Arjun Koch³⁸, Srinadh Komanduri⁴⁰, Vani Konda⁴¹, Koen C Kusters²⁷, Philippe Leclerq²⁶, Cadman L Leggett³⁷, Charles J Lightdale⁴², Rosalie C Mallant-Hent⁴³, Guiomar Moral Villarejo⁴⁴, V Raman Muthusamy⁴⁵, Jacobo Ortiz Fernández-Sordo⁴⁴, Oliver Pech⁴⁶, Ian Penman⁴⁷, Roos E Pouw²⁴, Joost A van der Putten²⁷, Krish Ragunath⁴⁸, Pieter Scholten⁴⁹, Stefan Seewald⁵⁰, Amritha Sethi⁴², Michael S Smith⁵¹, Fons van der Sommen²⁷, Arvind Trindade⁵², Sachin Wani⁵³, Irving Waxman⁵⁴, Jessie Westerhof⁵⁵, Bas L Weusten⁵⁶, Peter H de With²⁷, Herbert C Wolfsen⁵⁷

Affiliations

¹ Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
² Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.
³ Department of Gastroenterology and Hepatology, UMC Utrecht, University of Utrecht, Utrecht, the Netherlands; Department of Gastroenterology and Hepatology, Sint Antonius hospital, Nieuwegein, the Netherlands.
⁴ Department of Gastroenterology and Hepatology, Sint Antonius hospital, Nieuwegein, the Netherlands.
⁵ Department of Gastroenterology and Hepatology, HagaZiekenhuis Den Haag, Den Haag, the Netherlands.
⁶ Department of Gastroenterology and Hepatology, UMC Groningen, University of Groningen, Groningen, the Netherlands.
⁷ Department of Gastroenterology and Hepatology, Isala Hospital Zwolle, Zwolle, the Netherlands.
⁸ Department of Gastroenterology and Hepatology, Flevoziekenhuis Almere, Almere, the Netherlands.
⁹ Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.
¹⁰ Department of Gastroenterology and Hepatology, Royal Perth Hospital, Curtin University, Perth, Australia.
¹¹ Department of Gastroenterology and Hepatology, Hirslanden Klinik, Zurich, Switzerland.
¹² Department of Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden; Division of Surgery, Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
¹³ Department of Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden; Center for Advanced Endoscopy Carlos Moreira da Silva, Gastroenterology Department, Pedro Hispano Hospital, ULSM Matosinhos, Portugal.
¹⁴ Department of Gastroenterology and Hepatology, Cochin hospital Paris, Paris, France.
¹⁵ Department of Gastroenterology and Hepatology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.
¹⁶ Department of Gastroenterology and Hepatology, St. John of God Hospital, Regensburg, Germany.
¹⁷ Department of Gastroenterology and Hepatology, Evangalisches Krankenhaus Düsseldorf, Düsseldorf, Germany.
¹⁸ Biostatistics Unit, Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
¹⁹ Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands. Electronic address: j.j.bergman@amsterdamumc.nl.
²⁰ Isala Hospital, Zwolle, the Netherlands.
²¹ St. Antonius Hospital, Utrecht, the Netherlands.
²² Karolinska University Hospital, Stockholm, Sweden.
²³ Cochin Hospital, Paris, France.
²⁴ Amsterdam UMC, Amsterdam, the Netherlands.
²⁵ Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany.
²⁶ University Hospitals Leuven, Leuven, Belgium.
²⁷ TU Eindhoven, Eindhoven, the Netherlands.
²⁸ Catharina Hospital, Eindhoven, the Netherlands.
²⁹ University Hospital Saint-Luc, Brussels, Belgium.
³⁰ Karolinska University Hospital & Karolinska Institute, Stockholm, Sweden.
³¹ Clínico San Carlos, Madrid, Spain.
³² Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States.
³³ University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States.
³⁴ Cleveland Clinic London and University College Hospitals NHS, London, United Kingdom.
³⁵ HagaZiekenhuis, The Hague, the Netherlands.
³⁶ Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States.
³⁷ Mayo Clinic, Rochester, Minnesota, United States.
³⁸ Erasmus MC, Rotterdam, the Netherlands.
³⁹ Amsterdam UMC, Amsterdam the Netherlands.
⁴⁰ Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States.
⁴¹ Baylor University Medical Center, Dallas, Texas, United States.
⁴² Columbia University Medical Center, New York, New York, United States.
⁴³ Flevoziekenhuis, Almere, the Netherlands.
⁴⁴ Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.
⁴⁵ UCLA Health, Los Angeles, California, United States.
⁴⁶ St. John of God Hospital, Regensburg, Germany.
⁴⁷ Royal Infirmary Edinburgh, Edinburgh, United Kingdom.
⁴⁸ Royal Perth Hospital, Perth, Australia.
⁴⁹ Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.
⁵⁰ Klinik Hirslanden, Zurich, Switzerland.
⁵¹ Mount Sinai West & Mount Sinai Morningside Hospitals, New York, New York, United States.
⁵² Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, New Hyde Park, New York, New York, United States.
⁵³ University of Colorado Anschutz Medical Center, Aurora, Colorado, United States.
⁵⁴ Rush University Medical Center, Chicago, Illinois, United States.
⁵⁵ UMC Groningen, Groningen, the Netherlands.
⁵⁶ UMC Utrecht & St. Antonius Hospital, Utrecht, the Netherlands.
⁵⁷ Mayo Clinic, Jacksonville, Florida, United States.

PMID: 38636819
DOI: 10.1016/j.gie.2024.04.013

Abstract

Background & aims: Characterization of visible abnormalities in Barrett esophagus (BE) patients can be challenging, especially for unexperienced endoscopists. This results in suboptimal diagnostic accuracy and poor inter-observer agreement. Computer-aided diagnosis (CADx) systems may assist endoscopists. We aimed to develop, validate and benchmark a CADx system for BE neoplasia.

Methods: The CADx system received pretraining with ImageNet with consecutive domain-specific pretraining with GastroNet which includes 5 million endoscopic images. It was subsequently trained and internally validated using 1,758 narrow-band imaging (NBI) images of early BE neoplasia (352 patients) and 1,838 NBI images of non-dysplastic BE (173 patients) from 8 international centers. CADx was tested prospectively on corresponding image and video test sets with 30 cases (20 patients) of BE neoplasia and 60 cases (31 patients) of non-dysplastic BE. The test set was benchmarked by 44 general endoscopists in two phases (phase 1: no CADx assistance; phase 2: with CADx assistance). Ten international BE experts provided additional benchmark performance.

Results: Stand-alone sensitivity and specificity of the CADx system were 100% and 98% for images and 93% and 96% for videos, respectively. CADx outperformed general endoscopists without CADx assistance in terms of sensitivity (p=0.04). Sensitivity and specificity of general endoscopist increased from 84% to 96% and 90 to 98% with CAD assistance (p<0.001), respectively. CADx assistance increased endoscopists' confidence in characterization (p<0.001). CADx performance was similar to Barrett experts.

Conclusion: CADx assistance significantly increased characterization performance of BE neoplasia by general endoscopists to the level of expert endoscopists. The use of this CADx system may thereby improve daily Barrett surveillance.

Keywords: BONS-AI; Barrett’s OesophaguS Imaging for Artificial Intelligence.